Bone Marrow Involvement at Onset of Hodgkin's Disease

Bilateral trephine bone marrow biopsies of 370 patients with Hodgkin's disease first seen at the Institute of Hematology, University of Rome, between 1970 and 1981, revealed tumor involvement of the bone marrow in 18 cases. The histologic type was mixed cellularity in 7 cases, lymphocytic depletion in 4 cases, nodular sclerosis in 4 cases, and lymphocytic prevalence in 1 case. Anemia with less than 10 g/dl of hemoglobin was observed in 5 patients; white blood cells were less than 4.0 × 109/liter in 2 patients; platelets were less than 12.0 × 109/liter in 1 case; a pancytopenic condition was observed in only 1 case. B symptoms were present in 14 of the 18 patients. All patients who underwent laparosplenectomy presented spleen involvement, 4 also had liver involvement. All patients were treated with chemotherapy; MOPP regimen was employed in 11 cases, ABVD in 5 patients, and PROVECIP in 1 case. Of the 13 patients evaluable for therapeutic response, 11 achieved complete remission, with a median actuarial relapse-free survival of 15 months. The actuarial survival curve showed that 50% of all patients are projected alive at 47 months with a follow-up ranging from 1 to 109 months.

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Bone Marrow Involvement in Hodgkin's Disease: Pathology and Response to MOPP Chemotherapy

Blood ◽

10.1182/blood.v44.2.197.197 ◽

1974 ◽

Vol 44 (2) ◽

pp. 197-204 ◽

Cited By ~ 48

Author(s):

C. E. Myers ◽

B. A. Chabner ◽

V. T. De Vita ◽

H. R. Gralnick

Keyword(s):

Bone Marrow ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement ◽

Response To Therapy ◽

Risk Of Infection ◽

Bone Marrow Biopsies ◽

Increased Risk ◽

Tumor Involvement ◽

Marrow Fibrosis

Abstract Examination of the bone marrow biopsies of 174 patients with Hodgkin’s disease seen at the National Cancer Institute between 1965 and 1972 revealed tumor involvement of the marrow in 19 cases. Eighteen of the 19 patients were treated with intensive combination chemotherapy (MOPP), and 13 achieved complete remission; the median duration of remission was 25+ mo, and 49% of those at risk remained in continuous remission for at least 3 yr. In all patients with marrow involvement, marrow fibrosis due to increased collagen or reticulin was identified in the pretreatment specimen. Repeat biopsies following therapy revealed entirely normal marrow free of tumor and reticulin or collagen fibrosis in eight patients, although residual collagen was detected in three other patients. Pretreatment leukopenia (WBC less than 5000 cells per cu mm) was present in seven of the 18 patients treated with MOPP, and appeared to be associated with an increased risk of infection and a less favorable response to therapy. These results indicate that nonleukopenic patients with Hodgkin’s disease and bone marrow involvement can be safely and effectively treated with intensive chemotherapy, and that pathologic changes in the marrow, including diffuse myelofibrosis, are often reversible with such therapy.

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Chemotherapy-Radiotherapy versus Chemotherapy in Hodgkin’s Disease with Bone Marrow Involvement

Acta Haematologica ◽

10.1159/000207125 ◽

1981 ◽

Vol 66 (4) ◽

pp. 217-225 ◽

Cited By ~ 3

Author(s):

J.M. Andrieu ◽

P. Cramer ◽

B. Asselain ◽

N. Tea ◽

G. Tricot ◽

...

Keyword(s):

Bone Marrow ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement

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CD30 (Ki-1)-positive malignant lymphomas: clinical, immunophenotypic, histologic, and genetic characteristics and differences with Hodgkin's disease

Blood ◽

10.1182/blood.v87.7.2905.bloodjournal8772905 ◽

1996 ◽

Vol 87 (7) ◽

pp. 2905-2917 ◽

Cited By ~ 44

Author(s):

DA Filippa ◽

M Ladanyi ◽

N Wollner ◽

DJ Straus ◽

JP O'Brien ◽

...

Keyword(s):

Bone Marrow ◽

B Cell ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement ◽

Skin Lesions ◽

Cell Phenotype ◽

Cell Type ◽

Null Cell

This study compares the histologic and immunophenotypic features of 71 cases of primary CD30+ diffuse large-cell lymphomas (DLCL) and 128 cases of Hodgkin's disease (HD) and discusses the clinical features of 52 patients with CD30+ DLCL. It includes analysis of sites of involvement, staging, response to treatment, sites and treatment of recurrences, and disease-free and overall survival. Diagnostic immunophenotypic differences were found between CD30+ DLCL and HD. All cases of CD30+ DLCL were positive for one or more common or lineage- specific lymphocyte antigens or for EMA. In contrast, 96.9% of HD cases were negative for CD45, CD45-RO, CD43, and CD20. The four exceptions are discussed. All cases of HD were negative for EMA. In patients with CD30+ DLCL, a T-cell phenotype was found in 60%, a null-cell type in 22%, and a B-cell type in 18% of the cases. The median age of patients with T- and null-cell phenotype was 22 years (range, 4 to 72). Fifty- two percent of them had high-stage (III and IV) disease and 61% had extranodal involvement at presentation, including 25% with skin lesions. Lymph nodes draining the skin lesions became involved in seven of 11 patients. No patient had initial bone marrow involvement. Most patients were treated with chemotherapy, and 83% had a complete remission. Fifty-four percent remain free of disease with a median follow-up of 47 months. Thirteen patients (29%) had one or more recurrences and five of them remain free of disease after salvage therapy, with a median follow-up period of 79 months. The clinical stage did not affect survival, probably as a result of different therapy. The t(2;5) translocation was found in five of 15 patients who had cytogenetic abnormalities. Of the other 10 cases, the translocation was detected by reverse transcriptase-polymerase chain reaction (RT- PCR) in four of five cases studied. All nine cases were of T- or null- cell phenotype. The cases of B-cell CD30+ DLCL had a characteristic immunophenotype. All were negative for EMA. These patients were older and had frequent bone marrow involvement but no skin infiltration by lymphoma. All three patients who were human immunodeficiency virus- positive (HIV+) had lymphomas of B-cell lineage. Detection of the t(2;5) translocation by molecular genetics is a useful and highly specific marker in the differential diagnosis between HD and CD30+ DLCL.

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Bone marrow involvement in Hodgkin's disease: an analysis of 135 consecutive cases. German Hodgkin's Lymphoma Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.2.403 ◽

1995 ◽

Vol 13 (2) ◽

pp. 403-409 ◽

Cited By ~ 66

Author(s):

R Munker ◽

D Hasenclever ◽

O Brosteanu ◽

E Hiller ◽

V Diehl

Keyword(s):

Bone Marrow ◽

Hodgkin's Disease ◽

Hodgkin’S Lymphoma ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement ◽

Stage Iv ◽

Hodgkin's Lymphoma ◽

Study Group ◽

Prognostic Relevance ◽

Lymphoma Study Group

PURPOSE To describe the incidence of primary bone marrow involvement (BMI) in Hodgkin's disease (HD) and its correlation with clinical and laboratory features present at diagnosis, and to evaluate the prognostic relevance of BMI. PATIENTS AND METHODS Between 1983 and 1991, 2,307 patients with HD were treated according to two trial generations (HD1-3 and HD4-6) of the German Hodgkin's Lymphoma Study Group (GHSG). RESULTS One hundred thirty-five cases of primary BMI were observed. The incidence of BMI was 4.8% in the HD4-6 study generation, which included all stages. Among stage IV patients, 32% had BMI. Among those with BMI, other organs were also involved in 33%. Among all patients, the presence of BMI was significantly associated with B symptoms, lymph nodes on both sides of the diaphragm, mixed cellularity histologic subtype, leukocytopenia, anemia, thrombocytopenia, lactate dehydrogenase (LDH) level more than 400 U/L, and erythrocyte sedimentation rate (ESR) more than 40 mm/h. BMI was negatively correlated with a large mediastinal tumor (3.7% v 20.0% in non-BMI cases). Eighty-seven of 108 (81%) assessable patients with BMI achieved a complete remission (CR). This compares favorably with the overall CR rate in all stage IIIB/IV patients. Among stage IV patients, BMI has no prognostic relevance with regard to freedom from treatment failure and overall survival. Twenty-one patients with BMI relapsed after having achieved a CR. Only five of these (24%) again had a positive bone marrow biopsy. CONCLUSION The prognosis of patients with BMI is not worse than the prognosis of other advanced-stage HD patients. BMI alone does not define a special high-risk group in which a different treatment approach is indicated.

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1006 Prognostic value of bone marrow involvement by Hodgkin's disease

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(03)91033-0 ◽

2003 ◽

Vol 1 (5) ◽

pp. S301

Author(s):

S. Kanaev ◽

S.N. Novikov ◽

L. Jukova ◽

M. Girschovich

Keyword(s):

Bone Marrow ◽

Hodgkin's Disease ◽

Prognostic Value ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement

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Cis-Dichlorodiammineplatinum (II), VP 16-213, and Prednisone (Dvp Regimen) in the Treatment of Pretreated Advanced Malignant Lymphomas

Tumori Journal ◽

10.1177/030089168206800611 ◽

1982 ◽

Vol 68 (6) ◽

pp. 515-518

Author(s):

Vinicio P. Fosser ◽

Luigi Salvagno ◽

Romana Segati ◽

Giovanni L. Pappagallo ◽

Eros Ferrazzi ◽

...

Keyword(s):

Bone Marrow ◽

Combination Chemotherapy ◽

Hodgkin's Disease ◽

Partial Remission ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement ◽

Malignant Lymphomas ◽

Schedule Interval ◽

Heavily Pretreated ◽

Pretreated Patients

Eighteen evaluable patients with advanced malignant lymphoma were treated with a combination of cis-dichlorodiammineplatinum (II) (50 mg/m2 i.v. on day 1), VP 16-213 (100 mg/m2 i.v. on days 1, 3, 5), and prednisone (50 mg/m2 per os on days 1–5), recycling every 2 weeks. All patients were previously pretreated. There were 3 complete remissions (patients with Hodgkin's disease), and 4 partial remission (2 patients with Hodgkin's and 2 with non-Hodgkin's lymphoma), for a median duration of 8 weeks. In addition, 2 minor responses (patients with Hodgkin's disease) were observed. Vomiting and myelosuppression were the most prominent toxic effects. In most heavily pretreated patients, myelosuppression was moderate to severe: in these patients and in patients with bone marrow involvement, a schedule interval of 3 weeks should be more appropriate. Nephrotoxicity was minimal. This combination chemotherapy showed some activity in the management of advanced malignant lymphomas; further studies in this area are justified.

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Peripheral T-Cell Lymphoma Simulating Hodgkin's Disease With Initial Bone Marrow Involvement

Mayo Clinic Proceedings ◽

10.1016/s0025-6196(12)61400-1 ◽

1986 ◽

Vol 61 (1) ◽

pp. 68-71 ◽

Cited By ~ 11

Author(s):

GERARDO COLON-OTERO ◽

STEPHEN P. McCLURE ◽

ROBERT L. PHYLIKY ◽

WILLIAM L. WHITE ◽

PETER M. BANKS

Keyword(s):

Bone Marrow ◽

T Cell ◽

Hodgkin's Disease ◽

Cell Lymphoma ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma

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Allogeneic bone marrow transplant is not better than autologous transplant for patients with relapsed Hodgkin's disease. European Group for Blood and Bone Marrow Transplantation.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.4.1291 ◽

1996 ◽

Vol 14 (4) ◽

pp. 1291-1296 ◽

Cited By ~ 174

Author(s):

N Milpied ◽

A K Fielding ◽

R M Pearce ◽

P Ernst ◽

A H Goldstone

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplantation ◽

Hodgkin's Disease ◽

Marrow Transplantation ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement ◽

Allogeneic Bone Marrow ◽

Allogeneic Bone ◽

Grade Ii ◽

Matching Criteria

PURPOSE To compare the results achieved with myeloablative therapy followed by either allogeneic bone marrow transplantation (alloBMT) or autologous bone marrow transplantation (ABMT) for patients with Hodgkin's disease (HD). PATIENTS AND METHODS Of more than 1,200 patients with HD reported to the European Bone Marrow Transplantation (EBMT) registry, 49 underwent alloBMT. Of these, 45 with sufficient data were matched to 45 patients who underwent ABMT. The matching criteria were sex, age at time of transplantation, stage of disease at diagnosis, bone marrow involvement at diagnosis and at transplantation, year of transplantation, disease status at time of transplantation, time from diagnosis to transplantation, and conditioning regimen with or without total-body irradiation (TBI). RESULTS The 4-year actuarial probabilities of survival, progression-free survival (PFS), relapse, and non-relapse mortality were 25%, 15%, 61%, and 48% and 37%, 24%, 61%, and 27% after alloBMT and ABMT, respectively. The toxic death rate at 4 years was significantly higher for alloBMT patients (P = .04). For patients with sensitive disease at the time of transplantation, the 4-year actuarial probability of survival was 30% after alloBMT and 64% after ABMT (P = .007). This difference is mainly due to a higher transplant-related mortality rate after alloBMT (65% v 12%, P = .005). Acute graft-versus-host disease (aGVHD) > or = grade II was associated with a significantly lower risk of relapse, but also with a lower overall survival (OS) rate. CONCLUSION Based on this study, alloBMT from a human leukocyte antigen (HLA)-identical sibling donor does not appear to offer any advantage when compared with ABMT. A graft-versus-Hodgkin effect is associated with > or = grade II aGVHD, but its positive effect on relapse is largely offset by its toxicity. In most circumstances, alloBMT cannot be recommended for patients with HD.

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